Orthopedic Coding Alert

Question: Under teaching guidelines, what is the proper way to bill for fracture treatment in the ED if performed by an orthopedic resident without an orthopedic staff present, and what would be the proper E/M code to use when followed up in the office?

Nancy Timmins
Orthopedic Surgery
WVU Medical Center

Answer: You cannot bill fracture care to Medicare unless the teaching physician (TP) is present.

Since no fracture care is billable, the follow-up office visits should be billed as rendered, using the appropriate level of evaluation and management services. To be billable, those services must also include the participation of the TP. Casting services are also billable when rendered.

Sources for reader questions: Susan Callaway-Stradley, CPC, an independent coding consultant in Augusta, SC; Sheri Benton, CPC, a coding and reimbursement specialist at the Cleveland Clinic Foundation, department of orthopedics; and Annette Grady, CPC, CPC-H, coding and reimbursement coordinator at the Bone and Joint Center in Bismarck, ND.